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Cowan, Robert M.; Trzeciak, Stephen

doi:10.1186/cc2981

Cited by 209 publications

(52 citation statements)

References 39 publications

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“…To address the perennial problem of a full ICU, aside from the intuitive but operationally complex solution of increasing the number of beds, other recommendations include increasing the availability of intermediate or step-down care 8 or alternative care areas for patients who require stabilisation; 13 deployment of medical emergency teams or intensive care outreach services for ward patients becoming critically ill; 13 18 26 27 and use of various models to expand physician coverage to provide critical care in the ED. 28 Other factors and proposed interventions include the development of ward care pathways for conditions which frequently lead to ICU admissions 15 and the development of predictive models and physiological early warning scores to identify incipient severe outcomes. 16 18 Bringing in some elements of intensive care such as ventilators to the general wards may not be enough to improve outcomes for critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of direct and indirect medical intensive care unit admissions from the emergency department of an acute care hospital: a retrospective cohort study

Molina¹,

Seow

Heng³

et al. 2014

BMJ Open

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ObjectivesThis study aimed to determine if the risk of adverse outcomes (in-hospital and 60-day mortality, intensive care unit (ICU) and total hospital length of stay (LOS)) was greater for medical ICU (MICU) or high dependency unit (HDU) patients indirectly admitted from the emergency department (ED) than for directly admitted patients.SettingThis study was conducted at a large public acute care hospital in Singapore.ParticipantsIn this retrospective cohort study, hospital records of patients who were admitted directly from the ED, or initially admitted to the general wards from the ED and subsequently transferred to the MICU/HDU within 24 h, were reviewed. Patients were included if they were: (A) discharged from the MICU/HDU in 2009 and were admitted from the ED and (B) transferred to the MICU/HDU within 24 h of presentation at the ED. Data from 706 patients were analysed; 58.4% were men with a median age of 61 years.Primary and secondary outcome measuresThe following outcomes were compared: in-hospital mortality, 60-day mortality, LOS at the MICU/HDU, as well as total hospital LOS.ResultsOf the 706 patients, 491 (69.5%) were directly admitted to the MICU/HDU. After adjusting for demographics, comorbidities, interventions at the ED and clinical parameters at the ED (heart rate, respiration, oxygen saturation, mean arterial pressure), as well as the Apache II score on arrival at the MICU/HDU, indirectly admitted patients had a higher risk of in-hospital mortality (OR=3.07, 95% CI 1.39 to 6.80), death within 60 days (OR=3.09, 95% CI 1.40 to 6.83) and risk of staying >1 day at the MICU/HDU (OR=2.54, 95% CI 1.48 to 4.36). There was no significant difference in total in-hospital LOS.ConclusionsIndirectly admitted MICU/HDU patients had generally poorer outcomes. As the magnitude of effect may vary across settings, context-specific studies may be useful for improving outcomes.

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Section: Discussionmentioning

confidence: 99%

Outcomes of direct and indirect medical intensive care unit admissions from the emergency department of an acute care hospital: a retrospective cohort study

Molina¹,

Seow

Heng³

et al. 2014

BMJ Open

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“…Both during times of clinically active care and time spent in the ED awaiting ICU admission, critically ill patients are resource intensive and may strain limited ED resources. Though the research is limited, there are several studies that suggest delay in the transfer of critically ill patients to the ICU is associated with poor outcomes including increased mortality (23, 34–38). As implementation of the Patient Protection and Affordable Care Act proceeds, adequate resource allocation to improve critical care capacity in U.S. EDs should be a priority.…”

Section: Discussionmentioning

confidence: 99%

Increasing Critical Care Admissions From U.S. Emergency Departments, 2001–2009*

Herring

Ginde

Fahimi

et al. 2013

Critical Care Medicine

119

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Objectives Little is known about how recent system-wide increases in demand for critical care have affected U.S. emergency departments (EDs). This study describes changes in the amount of critical care provided in U.S. EDs between 2001 and 2009. Design Analysis of data from the National Hospital Ambulatory Medical Care Survey for the years 2001–2009. Setting National multistage probability sample of U.S. ED data. U.S. ED capacity was estimated using the National Emergency Department Inventory-United States. Patients ED patients admitted a critical care unit. Interventions None. Measurements Annual hours of ED-based critical care and annual number critical care ED visits. Clinical characteristics, demographics, insurance status, setting, geographic region, and ED length of stay for critically ill ED patients. Main Results Annual critical care unit admissions from U.S. EDs increased by 79% from 1.2 to 2.2 million. The proportion of all ED visits resulting in critical care unit admission increased from 0.9% to 1.6% (ptrend < 0.001). Between 2001 and 2009, the median ED length of stay for critically ill patients increased from 185 to 245 minutes (+ 60 min; ptrend < 0.02). For the aggregated years 2001–2009, ED length of stay for critical care visits was longer among black patients (12.6% longer) and Hispanic patients (14.8% longer) than among white patients, and one third of all critical care ED visits had an ED length of stay greater than 6 hrs. Between 2001 and 2009, total annual hours of critical care at U.S. EDs increased by 217% from 3.2 to 10.1 million (ptrend < 0.001). The average daily amount of critical care provided in U.S. EDs tripled from 1.8 to 5.6 hours per ED per day. Conclusions The amount of critical care provided in U.S. EDs has increased substantially over the past decade, driven by increasing numbers of critical care ED visits and lengthening ED length of stay. Increased critical care burden will further stress an already overcapacity U.S. emergency care system.

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“…The use of ED services by frequent users can often be perceived as inappropriate and non-urgent [ 15 , 16 ], resulting in uncoordinated and less effective care as compared to what these patients would receive in primary care [ 17 , 18 ]. This situation generates substantial costs to the health care system [ 19 , 20 ], it decreases ED efficiency [ 2 ], and contributes to ED overcrowding [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with chronic frequent emergency department utilization in a population with diabetes living in metropolitan areas: a population-based retrospective cohort study

Hudon

Courteau

Krieg

et al. 2017

BMC Health Serv Res

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BackgroundA small proportion of patients utilizes a disproportionately large amount of emergency department (ED) resources. Being able to properly identify chronic frequent ED users, i.e. frequent ED users over a multiple-year period, would allow healthcare professionals to intervene before it occurs and, if possible, redirect these patients to more appropriate health services. The objective of this study was to explore the factors associated with chronic frequent ED utilization in a population with diabetes.MethodsA population-based retrospective cohort study using administrative data was conducted on 62,316 patients with diabetes living in metropolitan areas of Quebec (Canada), having visited an ED during 2006, and still alive in 31 December 2009. The dependant variable was being a chronic frequent ED user, defined as having at least 3 ED visits per year during three consecutive years (2007–2009). Independent variables, measured during 2006, included age, sex, neighbourhood deprivation, affiliation to a general practitioner, and number of physical and mental health comorbidities. Logistic regression and tree-based method were used to identify factors associated with chronic frequent ED use.ResultsA total of 2.6% of the cohort (patients with diabetes and at least one ED visit in 2006) was identified as chronic frequent ED users. These patients accounted for 16% of all ED visits made by the cohort during follow-up. The cumulative effect of a high illness burden combined with mental health disorders was associated with an increased risk of chronic frequent ED use.ConclusionsInterventions must target the population at higher risk of becoming chronic frequent ED users and should be designed to manage the complex interaction between high illness burden and mental health.

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Untitled

Cited by 209 publications

References 39 publications

Outcomes of direct and indirect medical intensive care unit admissions from the emergency department of an acute care hospital: a retrospective cohort study

Outcomes of direct and indirect medical intensive care unit admissions from the emergency department of an acute care hospital: a retrospective cohort study

Increasing Critical Care Admissions From U.S. Emergency Departments, 2001–2009*

Factors associated with chronic frequent emergency department utilization in a population with diabetes living in metropolitan areas: a population-based retrospective cohort study

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